Mid-year Affordable Care Act Update

August 25, 2014

Data on the first ACA enrollment period is beginning to surface. Perhaps the most notable development since the ACA’s implementation, according to a Gallup poll and other data, the uninsured rate has dropped nationwide to 13.4 percent, down from 17.1 percent. Three different studies (Gallup, the Commonwealth Fund, and the Urban Institute), have found a net reduction of uninsured adults from anywhere between 8 million to 11 million people.

Not surprisingly, the biggest improvements in insurance coverage have taken place in the 26 jurisdictions that have expanded their Medicaid programs. Higher numbers of uninsured are concentrated in those states that have declined the Medicaid expansion.

Although the studies varied in method, they arrived at a similar conclusion: nationwide, roughly 1 in 4 people who were uninsured last fall now have coverage, the vast majority of whom reported satisfaction with their new health plans.

87 percent of the more than 5.4 million enrollees who used HealthCare.gov to enroll before mid-April, received federal subsidies. In order for an individual to qualify for a subsidy, he/she had to have a projected annual income of 100 percent to 400 percent of the federal poverty level, or about $11,490 to $46,000.

The Commonwealth study found that many people still report being unaware of the new insurance marketplaces and an even greater number are unaware that the law provides tax subsidies for those who qualify. Ignorance of the law is highest among those living in or near poverty; ironically the group that the ACA helps the most.

According to healthcare analysis group, Avalere Health, many consumers in Exchange plans who currently receive subsidies could face substantial premium increases unless they switch plans in 2015. Avalere also reported that insurance premiums in some states might see double digit routine increases due to the rising costs of medical care, use of services, and new technology. New York, in particular, is projected to see an average premium hike of 12 percent for individuals and a number of firms want to boost premiums by nearly 20 percent.

As always, ADVOCATE will keep you updated on this and all issues impacting radiology as they become available.